Updated May 17, 2006

ACE Inhibitors

A class of medicine usually used to treat high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors also appear to protect people with diabetes from diabetic nephropathy (kidney disease).

People with diabetes are especially prone to hypertension (defined as a blood pressure level of 140/90 mm Hg or greater). Some 20% to 60% of individuals with diabetes have high blood pressure. Hypertension increases their risk not only of heart disease and stroke, but also of peripheral vascular disease, diabetic retinopathy, diabetic nephropathy, and possibly diabetic neuropathy. The American Diabetes Association (ADA) currently recommends a target blood pressure level of under 130/80 mm Hg in people with diabetes.

The ADA recommends a number of different measures for lowering blood pressure, including weight loss, sodium restriction, and exercise. When these measures aren’t enough, the addition of one or more medicines is warranted. There are several different classes of blood pressure drugs, including angiotensin-receptor blockers (ARBs), diuretics, beta blockers, and ACE inhibitors. Overall, drug therapy has been shown to substantially decrease the risk of cardiovascular disease, diabetic retinopathy, and diabetic nephropathy.

ACE inhibitors may have a special advantage in terms of slowing the progression of diabetic nephropathy. Research findings show that ACE inhibitors can slow the progression of kidney disease to a greater degree than other antihypertensive drugs that lower blood pressure by a similar amount and that they may be able to protect the kidneys even in people with diabetes whose blood pressure levels are in the normal range. This suggests that ACE inhibitors protect the kidneys by mechanisms other than just blood pressure control.

Currently, the ADA recommends ACE inhibitors for people with high blood pressure and microalbuminuria or clinical albuminuria (clinical markers of kidney disease). The ADA also recommends that ACE inhibitors be considered for people over 55 with or without high blood pressure but with another cardiovascular risk factor (such as a history of cardiovascular disease, abnormal blood lipid levels, microalbuminuria, or smoking).

ACE inhibitors include quinapril (Accupril), perindopril (Aceon), ramipril (Altace), captopril (Capoten), benazepril (Lotensin), trandolapril (Mavik), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), and enalapril (Vasotec). Pregnant women should not take ACE inhibitors.

This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management.

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